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Program Integrity in Iowa Medicaid

Program Integrity is charged with reducing fraud, waste and abuse in the Iowa Medicaid program. Federal legislation under the Deficit Reduction Act (DRA) of 2005 and the Affordable Care Act (ACA) of 2010, as well as S.F. 357 enacted in 2013 by the 85th Iowa General Assembly has provided Iowa Medicaid Program Integrity with the tools and guidance to take action to reduce fraud, waste and abuse in the Medicaid program. The Iowa Medicaid Enterprise has developed this webpage dedicated to provide you with information and resources related to Medicaid Program Integrity.

For questions, inquiries, or to report fraud, waste, or abuse,contact the Iowa Medicaid Program Integrity Unit at 1-877-446-3787 (toll-free) or at 515-256-4615 (locally in Des Moines)

News and Announcements

Iowa Medicaid Provider Sanctions List:The Iowa Code section 249.49 (2013 Acts, ch 24, § 13) directs the Iowa Medicaid Program Integrity Unit to maintain an up-to-date list of providers that are found to be in violation of the Iowa Medicaid Program. This list identifies all providers that the Iowa Medicaid Program Integrity Unit has terminated, suspended, or placed on probation after administrative appeals have been exhausted, all providers that have failed to return an identified overpayment of medical assistance within the time frame specified in Iowa Code section 249A.39, and all providers found liable for a false claims law violation related to the medical assistance program under Iowa Code chapter 685.

Medicaid Program Integrity: Toolkits to Address Frequent Findings: 42 CFR 455.104; Disclosures of Ownership and Control: The Centers for Medicare and Medicaid Services (CMS) recently released Medicaid Program Integrity: Toolkits to Address Frequent Findings: 42 CFR 455.104; Disclosures of Ownership and Control Toolkit. The Disclosures of Ownership and Control Toolkit address common issues for states when collecting appropriate disclosures for persons with ownership or control interest. Although managed care entities (MCEs) are not mandated by this federal regulation to obtain ownership and control disclosures from their network providers, CMS considers the requirements under the regulation to be program safeguards that would be prudent to apply in managed care settings.

Payment Error Rate Measurement (PERM):Iowa is participating in the Federal Fiscal Year 2014 PERM program. This means that you may be contacted by the CMS national contractor, A+ Government Solutions, Inc., who will collect medical records from you either in hardcopy or electronic format. The medical records request letters will be sent to Iowa Medicaid enrolled providers between June 1, 2014 and August 31, 2014. For more information please review Informational Letters 1340 and 1386. CMS has also supplied a brief educational video describing the PERM review process.

Program Integrity Provisions of the Affordable Care Act (ACA) for Provider Enrollment and Screening: To improve the program integrity of the Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) programs, the Patient Protection and Affordable Care Act (ACA) requires these programs to screen and enroll all providers associated with the program. For the Iowa Medicaid Enterprise (IME), the new requirements are more extensive than the previous screening procedures and include enrolling providers who were not previously required to enroll in Medicaid.